Dataset Information

Hip Arthroscopy and Core Decompression for Avascular Necrosis of the Femoral Head Using a Specific Aiming Guide: A Step-by-Step Surgical Technique.

ABSTRACT: Avascular necrosis of the femoral (AVN) head is a disabling disease that affects function, mobility, and quality of life in the young adult. Its pathology involves blood circulation disruption of the femoral head and subchondral infarction. This leads to cartilage thinning, femoral head depression, and cartilage breakage, which results in hip osteoarthritis. In the past decade the prevalence of intraarticular pathology has been almost 95%, this revealed with hip arthroscopy (HA). HA and core decompression (CD) of the femoral head can be used effectively and concomitantly to treat AVN with excellent results, HA allows for excellent visualization of the hip joint cartilage, allowing treatment of femoroacetabular impingement syndrome (FAIS) and intra-articular pathology. Our technique demonstrates that retrograde core decompression with allograft and mixed bone matrix is an excellent choice of treatment in the early stages of AVN/ONFH. The femoral head-specific aiming guide is very reliable, is simple to use arthroscopically if placed in the posterolateral portal of the hip, and offers exact pin placement at the necrotic site, as well as less operative time and less radiation to the patient and surgical team.

SUBMITTER: Salas AP

PROVIDER: S-EPMC8719135 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Hip Arthroscopy and Core Decompression for Avascular Necrosis of the Femoral Head Using a Specific Aiming Guide: A Step-by-Step Surgical Technique.

Salas Antonio Porthos AP Mazek Jacek J O'Donnell John J Mendez-Perez Eder E Brizuela-Ventura Miguel M Velasco-Vazquez Hector Armando HA Meza Facundo F

Arthroscopy techniques 20211129 12

Avascular necrosis of the femoral (AVN) head is a disabling disease that affects function, mobility, and quality of life in the young adult. Its pathology involves blood circulation disruption of the femoral head and subchondral infarction. This leads to cartilage thinning, femoral head depression, and cartilage breakage, which results in hip osteoarthritis. In the past decade the prevalence of intraarticular pathology has been almost 95%, this revealed with hip arthroscopy (HA). HA and core dec ...[more]

PMID: 35004160

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Project description:Avascular necrosis of the femoral head (AVNFH) is a debilitating disease that requires early intervention to prevent subchondral collapse and irreversible damage leading to premature hip replacement. Patients presenting with AVNFH can have concomitant intra-articular pathology, including femoroacetabular impingement (FAI), that contributes to their hip pain and dysfunction. It is important to restore the native hip anatomy in addition to providing revascularization of necrotic areas to reduce pain, improve function, and maximize efforts to preserve the joint. The purpose of this Technical Note is to describe our preferred arthroscopic approach to core decompression through the femoral neck in combination with femoral osteoplasty to address AVNFH and FAI in a single-staged and minimally invasive procedure. Technique Video Video 1 Before standard hip arthroscopy, bone marrow aspirate concentrate harvest is performed using the ipsilateral posterior superior iliac spine, with the contralateral side being used if more aspirate is needed. The patient is placed in the modified supine position. Anterolateral and midanterior portals are placed. An interportal capsulotomy is performed followed by a diagnostic arthroscopy to identify any intra-articular pathology. After any necessary central compartment work and osteoplasty of the femoral neck are performed, the focus is changed to the area of avascular necrosis of the femoral head for the core decompression. The femoral head can be distracted with traction, and the area of avascular necrosis (AVN) is verified to be viable tissue with a 3 mm–long hip probe placed in the central defect. Bleeding may be verified on the periphery of the defect. Additionally, the lateral epiphyseal blood vessels can be visualized to be intact, and blood flow can be appreciated by pulse visualization or with a Doppler ultrasound probe. Core decompression is then performed with a 1.5 mm JuggerKnot drill in a retrograde fashion to decompress the area from the femoral neck to the site of the lesion within the femoral head. Fluoroscopy can be used to confirm the trajectory and depth of the drill into the area of AVN. Multiple passes are made with the drill, and bleeding is noted with the passes after arthroscopic fluid is turned off. The number of passes is variable with the objective of stimulating bleeding throughout the defect; typically this is between 5 and 10. The shaver is used to create a suction effect to illustrate that blood is coming through the drill holes. A key aspect of this technique is the creation of a relatively large number of small-diameter tunnels rather than 1 large-diameter tunnel, with the primary aim of stimulating blood flow more diffusely throughout the area of necrosis and avoiding the creation of an unnecessarily large cortical defect. The concentrated bone marrow aspirate collected earlier is then injected into these drill holes. Last, capsular closure is performed.

Dataset Information

Hip Arthroscopy and Core Decompression for Avascular Necrosis of the Femoral Head Using a Specific Aiming Guide: A Step-by-Step Surgical Technique.

Publications

Hip Arthroscopy and Core Decompression for Avascular Necrosis of the Femoral Head Using a Specific Aiming Guide: A Step-by-Step Surgical Technique.

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